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Dear Dr XXXXXXX Thanks For Your Earlier Advice On My

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Posted on Sun, 5 Jan 2020
Question: Dear Dr XXXXXXX

Thanks for your earlier advice on my niece BMT conditions for SAA re. the thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=396724

1.     My niece is now in day 53. Her fever that persist since pre-conditioning regimen has subsided in late November, but in these few days get up again between 37.5 to 37.8 again. Do we need to worry? Doctor last week in follow up consultation said that test showed no more CMV but still need to continue with the medication (I think she refers to ganciclovir)

Other problems also arose

2.     Her neutral has risen by one month time to around 2.7, platelet to over 85k. Hgb no notable improvement and still on RBC transfusion. But since early Dec, her platelets drop to 60+ and then early this week to 40+. We are scared that it may be secondary failure of platelet engraftment. Dr said it may be due the drug being taken. She asked my niece to start taking Eltrombopag 25 mg daily. Her Hgb is still low without notable rising trend? This adds to our fear of engraftment failure.

Dr. XXXXXXX any advice/coments? While her platelet counts seem rising but sudden dip down, we are so worried. Is this common to have this kind of pattern?

3.     If really secondary failure of engraftment, what will happen to my niece? Fatal?

4.     Her blood pressure has been high since transplant and is taking amlopidine daily, but is not controlling well and has just increased the dosage. Is this common in BMT receipients? Will it be transient or life long?

5.     Will my niece’s body and health conditons eventually become similar to the donor? My niece’s immune system will change eventually and my niece will develop similar health conditions/problems as the donor?
6. An

We are very worried about the current conditions. Seems very unstable and unpredictable, with many complications popping up. Look forward to your advice and any specific suggestions for us to face and handle the current situation.
doctor
Answered by Dr. Indranil Ghosh (5 hours later)
Brief Answer:
These are known problems after MUD transplant

Detailed Answer:
Hi
Thanks for following up.

My answers to your queries..

1. CMV seems to be controlled now so it's a good sign.

2. Platelets and hemoglobin may be low because of ganciclovir. Doesn't seem to be engraftment failure.

3. Secondary engraftment failure is difficult to manage. If all other causes are excluded, then a second transplant from same donor can be helpful.

4. Blood pressure elevation is not uncommon. Mostly it will subside later.

5. Immune system will definitely change if transplant is successful but not necessarily all problems of donor will surface in her. Rarely some does.

6. Yes I understand your concerns. MUD transplant in aplastic anemia, after so many transfusions is a challenging treatment. Ups and downs are inevitable. Hopefully she will tide over all of these.

hope this helps.
regards
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
Dr.
Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1712 Questions

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Dear Dr XXXXXXX Thanks For Your Earlier Advice On My

Brief Answer: These are known problems after MUD transplant Detailed Answer: Hi Thanks for following up. My answers to your queries.. 1. CMV seems to be controlled now so it's a good sign. 2. Platelets and hemoglobin may be low because of ganciclovir. Doesn't seem to be engraftment failure. 3. Secondary engraftment failure is difficult to manage. If all other causes are excluded, then a second transplant from same donor can be helpful. 4. Blood pressure elevation is not uncommon. Mostly it will subside later. 5. Immune system will definitely change if transplant is successful but not necessarily all problems of donor will surface in her. Rarely some does. 6. Yes I understand your concerns. MUD transplant in aplastic anemia, after so many transfusions is a challenging treatment. Ups and downs are inevitable. Hopefully she will tide over all of these. hope this helps. regards